替格瑞洛改善NSTE-ACS患者PCI术后氯吡格雷抵抗的研究  

Relieve effect of ticagrelor on clopidogrel resistance in patients with non-ST elevation-acute coronary syndrome

作　　者：贺学魁[1] 赵英娟[2] HE Xue-kui;ZHAO Ying-juan(Department of Cardiovasology, Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang 712000, China)

机构地区：[1]陕西中医药大学第二附属医院心血管内科,咸阳712000 [2]延安大学咸阳医院内分泌科,咸阳712000

出　　处：《中国循证心血管医学杂志》2017年第2期222-224,227,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的通过血栓弹力图评价替格瑞洛治疗非ST段抬高型急性冠脉综合征(NSTE-ACS)患者经皮冠状动脉介入治疗(PCI)术后氯吡格雷抵抗的疗效和安全性。方法陕西中医药大学第二附属医院心内科PCI术后经血栓弹力图证实存在氯吡格雷抵抗(规律服用氯吡格雷的情况下血栓弹力图检测腺苷二磷酸诱导的血小板抑制率<30%)的120例NSTE-ACS患者,按照随机数字表随机分为氯吡格雷强化组(150 mg,1/d)和替格瑞洛组(90 mg,2/d)各60例,连续治疗后于第5 d和1月后复查血栓弹力图,对比两组腺苷二磷酸(ADP)诱导的血小板抑制率的变化;患者随访3个月,比较两组不良反应和主要不良心脏事件(MACE)发生率。结果两组患者在年龄、性别比例、合并症等基线资料比较差异均无统计学意义(P>0.05);两组第5 d和1月ADP诱导的血小板抑制率均较调整用药前升高(P<0.05);与氯吡格雷强化组比较,替格瑞洛组ADP诱导的血小板抑制率升高更明显(P<0.05)。3个月后两组患者均无严重出血事件,氯吡格雷强化组4例轻微出血,替格瑞洛组7例轻微出血和4例轻度呼吸困难,两组差异无统计学意义(P>0.05);氯吡格雷强化组5例MACE,替格瑞洛组仅2例,替格瑞洛有降低MACE事件发生率趋势,但差异无统计学意义(P>0.05)。结论氯吡格雷高剂量和替格瑞洛常规剂量均能降低血小板反应性,但替格瑞洛改善氯吡格雷抵抗更显著,且有减少MACE发生的趋势。Objective To review the curative effect and safety of ticagrelor through thrombelastogram(TEG)in treatment clopidogrel resistance in patients with non-ST elevation-acute coronary syndrome(NSTE-ACS)afterpercutaneous coronary intervention(PCI).Methods NSTE-ACS patients with clopidogrel resistance affirmed byTEG(n=120,platelet inhibition ratio<30%induced by ADP detected with TEG during regular taking clopidogrel)were chosen from the Department of Cardiovasology of the Second Affiliated Hospital of Shaanxi University ofChinese Medicine.All patients were randomly divided into clopidogrel group(150mg once a day)and ticagrelorgroup(90mg twice a day,each n=60),and then were given re-examination of TEG after treatment for5d and1m.The changes of platelet inhibition ratio induced by ADP were compared between2groups.The patients werefollowed up for3m,and the incidence of adverse reactions and major adverse cardiovascular events(MACE)werecompared between2groups.Results The difference in age,sex and complications had no statistical significancebetween2groups(P>0.05).The platelet inhibition ratio induced by ADP increased after treatment for5d and1m in2groups(P<0.05),which was more significant in ticagrelor group compared with clopidogrel group(P<0.05).After treatment for3m,there were no severe bleeding events observed in2groups.There were4cases of mildbleeding in clopidogrel group,and7of mild bleeding and4of mild dyspnea in ticagrelor group(P>0.05).Therewere5cases of MACE in clopidogrel group and2in ticagrelor group,and ticagrelor had a trend of reducing MACEincidence,but the difference had no statistical significance(P>0.05).Conclusion Clopidogrel in higher dose andticagrelor in routine dose all can reduce platelet reactivity,while ticagrelor’s effect is more significant and it has atrend of reducing MACE incidence.

关 键 词：非ST段抬高型急性冠脉综合征 氯吡格雷抵抗 替格瑞洛 血栓弹力图 

分 类 号：R541.4[医药卫生—心血管疾病]